Society for Social Work and Research 17th Annual Conference: Social Work for a Just Society: Making Visible the Stakes and Stakeholders

January 16 - 20, 2013

Background and Purpose:  Practitioners and policy makers have become increasingly aware of the complex, ongoing, and changing service needs of persons with severe mental illness (SMI) and their families. The goal of this symposium is to explore the contextual events and experiences that contribute to severe mental health conditions in adulthood as well as the prodromal symptoms of psychosis experienced by youth at clinical risk.

Methods: The proposed symposium focuses on contextual issues related to the mental health of youth and adults from three unique perspectives.  The first paper explores the impact of separation from parents through age 16 on mental health outcomes among participants in the National Comorbidity Survey Replication, a cross-sectional US survey that examines the prevalence and correlates of mental health disorders in the general population. The second paper examines cross-sectional and longitudinal associations between stress measures and symptoms in clinical high risk patients (n=65) and demographically-matched controls. The authors compared the high risk cohort and healthy controls at baseline on measures of symptom severity and stress, and used generalized estimating equation analyses to examine covariation between stress measures and symptoms in high risk patients assessed quarterly for up to 4 years.  The third paper uses open-ended interviews conducted with high risk youth in a “prodromal” clinic to document subjective description in an effort to describe and understand this experience. The authors conducted a phenomenological analysis of the transcripts using consensus review to better understand the configuration of experience among this vulnerable population and to compare and contrast the difference among young men and women.

 

Results:

In paper one, findings suggest that childhood separation from a parent increases risk for severe mental health outcomes, especially if this separation included foster care or otherwise leaving the home prior to age 16. In paper two, impaired tolerance to daily stress was associated with a wide range of sub-threshold psychotic symptoms, depression and anxiety, and functioning, consistent with it being a core feature of the psychosis risk state. Self-reported exposure to major stressful life events, however, was not associated with symptoms or function.  In paper three, themes from the phenomenological analysis reflect challenges faced as prodromal symptoms emerge during late adolescence and early adulthood, including changes experienced over time, past and current symptoms and impact of these symptoms, help seeking behavior, and future plans.

Conclusions:   Framed from a social work perspective, presenters will include a discussion of cross-system challenges and opportunities for practice, outreach, policy, and additional research among youth at risk for negative mental health outcomes.  Youth who have been separated from a parent for a range or reasons may well be among those who are at clinical high risk for severe mental health conditions.  Given increased vulnerability and the potential for overlap among youth experiencing separation from a parent through age 16 and those identified at clinical high risk for psychosis, additional research is needed to understand mental health risks and to develop and test interventions for specific sub-populations that can change trajectories, enhance resiliency, and improve outcomes.